Clinical Practice and Cases in Emergency Medicine

Including outpatient pharmacies in the medication reconciliation process upon hospital discharge isnot commonly performed. This case highlights the consequences of a patient refilling a discontinuedprescription for valproic acid (VPA). We present a 32-year old male found unresponsive after ingestingdelayed release divalproex sodium. Cerebral edema was visualized on magnetic resonance imaging.Hemodialysis and levo-carnitine treatment led to improved mental status, and VPA was discontinued.The same patient presented with VPA overdose eight months later after he continued to fill an outda tedprescription. This case highlights consequences of VPA toxicity; it also demonstrates an opportunity toimprove patient safety and high-value care by collaborating with outpatient pharmacies in the medicationreconciliation process upon hospital discharge.